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Rate Review and Rate Guides

The managed care regulation requires that states develop valid managed care capitation rates in accordance with generally accepted actuarial principles and practices.

2024-2025 Medicaid Managed Care Rate Development Guide

CMS is releasing the 2024-2025 Medicaid Managed Care Rate Development Guide for states to use when setting rates with respect to any managed care program subject to federal actuarial soundness requirements during rating periods starting between July 1, 2024 and June 30, 2025. The guide provides detail around CMS' expectations of information to be included in actuarial rate certifications, and the guide will be used as a basis for CMS’ review. Please direct any questions related to this guide to MMCratesetting@cms.hhs.gov.

View previous years’ rate-setting guidance: